37, 6

Znaczenie redukcji sieci połączeń synaptycznych dla patogenezy, obrazu klinicznego i przebiegu schizofrenii 951
Significance of synaptic connectivity reduction for pathogenesis, clinical picture and course of schizophrenia 951
Jolanta Rabe-Jabłońska
Summary
Synaptic connectivity disorders are significant in the pathogenesis of schizophrenia. Myelinization and abnormal function of oligodendroglia are the most important factors damaging synaptic connectivity. The main phase of the patohgenetic process leading to schizophrenia is the loss of synaptic connectivity below ctritical level, dependent on primary synaptic density (caused by genetic and perinatal factors), and on elimnation of synaptic connection during late adolescence and early adulthood. Various clinical pictures and courses of schizophrenia are related to various levels of synaptic density reduction. New imaging techniques (MRI, MTI, DTI) found many abnormalities in white matter - in myelin and oligodendroglia in schizophrenics. Actually, we don't know, whether these abnormalities are primary (caused by genetic factors) or secondary (caused by other factors, fox example by glutamatergic excitotoxicity of oligodendroglia).

Zaburzenia metabolizmu lipidów w schizofrenii - aktualny stan wiedzy 965
Lipid abnormalities in schizophrenia - state of the art 965
Grzegorz Michalak
Summary
Preclinical and clinical data suggest that lipid abnormalities are involved in the pathogenesis of schizophrenia. The arguments in favour of this theory come from assessments of reduced tissue levels of essential fatty acids, altered phosphpolipases A2 enzyme activity and genetic studies on polymorphisms of their genes, increased brain levels of apolipoproteins D and L, increased turn-over of brain phospholipids in phosphorus-31 magnetic resonance spectroscopy, evaluation of the niacin flush test as a possible diagnostic marker and promising results of treatment trials using supplementation with eicosapentaenoic acid preparations, although some inconsistencies need further examination.

Rozkład latencji załamków wzrokowych potencjałów wywołanych w grupie pacjentów z rozpoznaniem schizofrenii 989
Distribution of latencies of visual evoked potentials in a sample of schizophrenic patients 989
Krzysztof Małyszczak, Marek Kubiszewski, Witold Pilecki, Andrzej Maciejowski, Małgorzata Sobieszczańska
Summary
Aim: The aim of the study is an analysis of distribution of visual evoked potentials (VEP) latencies in the group of schizophrenic and healthly subjects. Method: A study was carried out on a group of 30 patients (8 males and 22 females) with a DSM-III-R diagnosis of schizophrenia (disorganised schizophrenia - 5, paranoid schizophrenia - 12, residual schizophrenia - 6, and undifferentiated schizophrenia - 6). During the study 20 patients were given neuroleptics, 10 patients did not receive treatment. A control consisted of 50 healthy persons (25 males and 25 females). A stimulation of a chessboard pattern reversal (0.5 Hz, 30', 50 cd/m2) was applied. Evoked potentials were measured between top of a head (Cz) and occipital leads O1 and O2. Results: Schizophrenic patients have frequently prolonged N2 latency, and shortened P300 latency. Three groups of patients have been distinguished, based on a pattern of latencies: (1) patients with prolonged latencies of all the waves (half of the patients), (2) patients with prolonged N2 latency, and shortened P300 latency (one fourth of the patients), and (3) patients with latencies similar to control (one fourth of the patients).

Zmiana nasilenia sztywności emocjonalnej oraz jej wartość prognostyczna u pacjentów z rozpoznaniem schizofrenii w czasie leczenia neuroleptykami 999
Evaluation of the emotional blunting and its prognostic importance during neuroleptic treatment of schizophrenia 999
Dorota Kukulska
Summary
Emotional blunting is one of the basic negative symptoms in schizophrenia. This symptom, historically recognised as a static symptom in this disease, is not surrendering of treatment. Results of some new studies suggest, that the symptom of emotional blunting usually changes in the course of illness and during medical treatment. Thus, it is of prognostic significance. Aim: The aim of study is an assessment of the intensity of negative symptoms in patients with schizophrenia. Method: In the study, patients of both sexes treated in the Institute of Psychiatry and Neurology in Warsaw were examined. Seventy patients with schizophrenia were examined five times: before, during and after 8-week pharmacological treatment. The clinical status of patients was assessed by means of RSEB (which estimates presence and severity of emotional blunting); PANSS (which estimates all psychopathological symptoms); and CGI (general clinical condition of patients). Results: The statistical analysis showed a high level of emotional blunting in the investigated group. Also, there is a statistical significant correlation between the emotional blunting and the general patients' condition; decrease of emotional blunting during pharmacological treatment improves the results of CGI. Severity of emotional blunting before treatment is a predictive factor of its severity after treatment. There were no significant associations between the emotional blunting and other analysed factors: age, gender, number of hospitalisations, duration of illness, dose of drugs, global result of PANSS and severity of depressive symptoms.

Zjawisko wysycania się znaczeń a zaburzenia językowe w schizofrenii 1013
Semantic satiation and language disorders in schizophrenia 1013
Katarzyna Prochwicz
Summary
The term semantic satiation refers to the subjective experience of loss of meaning of a word as a result of prolonged repetition of that word. Satiation is a general property of neural activity: it reflects a spreading of activation in semantic networks and some type of inhibitory process. The aim of this paper is to present the hypothesis about the influence of the semantic satiation upon the language disorders in schizophrenia. This article contains a review of semantic satiation experiments in healthy participants, it also deals with the semantic priming paradigm, which was usually used to investigate this effect. The author presents a theoretical hypothesis about the connection between semantic satiation and language disorders. This hypothesis is based on a review of semantic priming experiments in schizophrenia, which provides the evidence that for schizophrenic patients the priming effect is larger than for healthy individuals. This hyperpriming effect suggests that schizophrenic patients are more susceptible to semantic satiation than healthy individuals, which may be a likely cause of a few of schizophrenia - related language disorders. Satiation may prove to be a useful tool for exploring the thought and language disorders in schizophrenia. Some empirical investigations should be made to verify the hypothesis which is described in this paper.

Porównanie jakości życia osób chorych na schizofrenię i ich opiekunów 1025
The quality of life of schizophrenic patients and their caretakers - comparison 1025
Małgorzata Chądzyńska, Katarzyna Spiridonow, Beata Kasperek, Joanna Meder
Summary
Aim: The aim of the research was to analyse the subjective quality of life of schizophrenic patients and their caretakers. Method: The quality of life was measured by the Polish adaptation of Mercier and Tempier's scale. We examined 50 patients and their relatives. Results: The patients' quality of life was compared to the quality of life of their relatives. They evaluate the quality of life similarly. The differences between the patients and their caretakers concern the evaluations of social relations. Only several demographic characteristics influenced quality of life. Conclusions: The similarity of quality of life is based on taking similar criterions of evaluation. The satisfaction from life was decreased for patients and their carers. It can be connected with the impact of schizophrenia on the family.

Charakterystyka psychiatrycznych oddziałów dziennych w Polsce - wyniki badania ankietowego 1037
Characteristics of a psychiatric day hospitals in Poland - results of a questionnaire survey 1037
Joanna Rymaszewska, Andrzej Kiejna, Tomasz Adamowski, Martyna Szurmińska, Tomasz Hadryś, Krzysztof Małyszczak, Elżbieta Trypka, Józef Zając, Joanna Jarosz
Summary
Aim: The survey was aimed at describing the characteristics and therapeutic means offered and the organizational structure of Polish day hospitals for adults as well the as characteristics of patients treated there. It was part of a wider international project carried out within a 5 EC Framework Program and focused on evaluation of costs and effectiveness of day hospital treatment when set against conventional stationary treatment in different European health care systems. Method: Data concerning the year 2000 were gathered using a self-designed questionnaire sent to respondents by post. The response ratio reached 65,2%. Results: Based on the cluster analysis, three main types of day hospitals were recognized: 1. day hospitals focused on rehabilitation of chronic mental disturbances, improvement of social functioning and support, 2. day hospitals being alternative to stationary inpatient treatment, 3. day hospitals intended to continue out-patient treatment and psychotherapy. The number of treatment places, working hours and workdays in a week in polled institutions was constant. Most frequent reasons for not admitting a patient to a day hospital were: intensive suicidal tendencies and acute psychotic decompensation. The most numerous diagnostic groups of patients treated there were schizophrenia (32,2%) and affective disorder (17,4%). Only 18,6% of day hospitals employed a qualified psychotherapist, and 32,6% had a social worker. On the average, one treatment place was offered to 5 patients during a year. Conclusions: The profile of patients admitted to Polish day hospitals for adults is not arbitrarily defined with respect to diagnosis and severity of disorder. However, it is possible to distinguish day hospitals, which have their preferences: more to rehabilitate or more to treat patients. In the last 16 years there was a threefold increase of the number of patients treated in day hospitals due to affective disturbances.

Drogi pacjentów do instytucji psychiatrycznej. I: Obszar badawczy "Ząbkowice" 1049
Pathways to psychiatric care. I: Ząbkowice epidemiological catchment area 1049
Tomasz Pawłowski, Andrzej Kiejna
Summary
Aim: The aim of this study was to characterise pathways to psychiatric care in the Ząbkowice epidemiological catchment area. Method: In the period of two months between 1st February 2001 and 31st March 2001 all patients age 15 and over who applied to the Psychiatric Service in the Ząbkowice catchment area, were assessed by psychiatrists for their eligibility to enter the study. Those who had fulfilled the entry criteria were interviewed using a Polish version of WHO's encounter form (EF) by the mental health professionals during their initial interview. Results: A total of 123 patients were seen. 43% of the patients in our sample contacted their general practitioner first compared with 20 % of those who first saw hospital doctors & medical specialists and 24 % who came direct. Conclusions: The study reveals that the median interval while receiving care was 14 weeks which is much longer than in all the European centres in previous studies (<5 weeks). We didn't find any coincidence between the total interval since the onset of symptoms to arrival at the Psychiatric Service and the duration of the patients' journey.

Drogi pacjentów do instytucji psychiatrycznej. II: Obszar badawczy "Psie Pole" 1063
Pathways to psychiatric care. II: "Psie Pole" epidemiological catchment area 1063
Tomasz Pawłowski, Andrzej Kiejna
Summary
Aim: The aim of this research was to draw a pathway diagram for people with mental disorders in Psie Pole epidemiological catchment area, which significantly differs from Ząbkowice epidemiological catchment area because of urbanisation and social status of citizens. Then to compare data characterising both pathways diagrams. Method: In the period of two months between 1st February 2001 and 31st March 2001 all patients age 15 and over who applied to the Psychiatric Service in the "Psie Pole" epidemiological catchment area, were assessed by psychiatrists for their eligibility to enter the study. Those who had fulfilled the entry criteria were interviewed using a Polish version of WHO's encounter form (EF) by the mental health professionals during their initial interview. Data from both catchment areas were compared. Results: In the "Psie Pole" and "Ząbkowice" catchments areas the main pattern of pathways to psychiatric care was similar. There were significant differences in the symptoms presented, diagnoses and intervals between both epidemiological catchment areas. Conclusions: The urban/semi urban and social status differences didn't influence the pathways to psychiatric care in "Psie Pole" and "Ząbkowice" catchment areas.

Telepsychiatria - internetowe porady psychiatryczne 1073
Telepsychiatry - Internet psychiatric advices 1073
Marek Krzystanek, Irena Krupka-Matuszczyk
Summary
Telepsychiatry is a medical service with a use of contemporary communication technologies. Internet and electronic mail are included. Aim: The aim of the study was to examine the use of electronic mail in psychiatric advices. Method: Anonymous electronic mails (327) sent to the author from June 2001 to May 2002 were selected. They were then processed according to the following criteria: patient age and gender, person who was a subject of consultation, reason and subject of a consultation and prevailing symptoms of a disease. Data frequencies were obtained. Results: 75% of patients referred their own psychiatric problem. The most frequent reasons of consultation were: a cry for help (44%), question about a disease (27%), consultation of a diagnosis (16%) or a therapy (13%). The biggest groups of symptoms related to fear (38%), disturbances of mood (18%), schizophrenic symptoms (13,5%) and sexual dysfunctions (10,5%). Conclusions: Psychiatrists on the Internet may expect an increase of electronic mail applicability in psychiatric advising. There is a need of medical, legal and ethical regulations of by-Internet doctor-patient relationship. Electronic mail may be treated as a source of knowledge on psychopathological symptoms and epidemiology of mental disturbances amongst the Internet users.

Badania eksperymentalne w polskich czasopismach psychiatrycznych 1083
Experimental studies in Polish psychiatric journals 1083
Krzysztof Małyszczak, Adrian Sieradzki, Andrzej Kiejna
Summary
Aim: Scientific studies in psychiatry from a methodological point of view could be divided into correlational and experimental. Experimental studies are based on active selection of independent and dependent variables, attributing values of the independent variable to persons under study and measuring values of dependent variables. An example of the experimental study is a comparison of two therapeutic methods. Experiments are feeble to selection, informational and confounding bias. Method: This review comprises experimental papers published in journals: "Psychiatria Polska", "Postępy Psychiatrii i Neurologii", "Farmakoterapia w Psychiatrii i Neurologii", "Rocznik Psychogeriatryczny", "Wiadomości Psychiatryczne" oraz "Alkoholizm i Narkomania" from January 1998 to December 2002. Results: 11 experimental publications, 6 randomised, 2 probably randomised and 3 case-control studies were found. The smallest study included 14 persons, the largest 180 persons. The number of experimental groups varied from 2 to 4. 9 studies evaluated features of specific methods of therapy and rehabilitation, among them 6 evaluated efficacy of medications. 2 studies evaluated relations between psychopathological and physiological variables. Experiments were based on groups of patients with a diagnosis of schizophrenia (3), alcohol and drug dependence (2), depression (3), insomnia (1), bronchial asthma (1), and hypertension (1). Conclusion: The review showed that experimental studies do not form a mainstream in Polish psychiatric journals.